Maybe it’s a hip fracture or pneumonia that sends your aging parent to the hospital. Or perhaps it’s a stroke or heart disease. Whatever the presenting medical condition and associated complications of recovery, there is one major risk of hospitalization for all older adults, regardless of diagnosis: delirium.

According to a recent publication by Harvard Medical School, delirium is “the most common complication of hospitalization among people ages 65 and older: 20% of those admitted to hospitals, up to 60% of those who have certain surgeries, and almost 80% of those treated in ICUs develop delirium.”

Some experience hallucinations, agitation, even belligerence, or so-called hyperactive delirium; others become withdrawn, lethargic and have difficulty waking, a condition known as hypoactive delirium. All struggle with confusion, a sense of disorientation and a disconnect with reality. Although those symptoms of delirium have been recognized by medical practitioners since the days of Hippocrates, the causes are still unknown. But the impact of acute delirium on an elder’s long-term health is sobering.

Dr. Mark Hammond, MD, a gerontologist who has worked with Memphis, Tenn., nursing homes for three decades, says that about a third of those who become delirious during a hospital stay are unable to get clear of the confusion and related symptoms—placing them at greater risk of additional health complications, both in the hospital and after discharge. “It causes a cascade of problems,” he says. “Their risk of death over the next 12 months doubles.”

Preventing delirium, says Hammond, can significantly alter the patient’s health trajectory. Studies of centers of excellence have shown that a combination of “common sense” treatment modalities can reduce the risk of delirium during hospitalization by 40 percent: oversight by a qualified gerontologist; ensuring the patient is well hydrated; early involvement of physical, occupational and speech therapists; prompting the patient to stay oriented to surroundings and current events; working on maintaining independence with activities of daily living—all help. So does music.

Hammond considers therapeutic use of music to be an essential part of the delirium-prevention mix. “Any music that is meaningful to the patient, the playlist of the person’s life, connections to childhood or adolescences—bridging neurological pathways can bring the patient back to reality,” he says.

Preferred Music Reduces Anxiety in Hospital Stays

In Scottsdale, Arizona, Dr. Kari Johnson, PhD, RN, ACNS-BC with HonorHealth, has been examining the connection between listening to favorite music and delirium prevention. For her doctoral thesis as a Hartford Scholar at Arizona Statue University, Johnson focused her research on how preferred music affected older patients in trauma centers.

A critical care nurse for much of her career, Johnson wondered what could ease a patient’s anxiety—a significant precursor of delirium—during hospital stays. “You have a person in a bed where you have all this unfamiliar stimuli,” she says. “They have IVs, they have alarms, people coming in and out. There is no sleep, no rest. You can see they’re anxious. They’re sick, and we need to have all this monitoring. What can we do to help ease their discomfort? I started to look at music. Everyone can relate to that.”

Johnson’s research led her to Dan Cohen and the work of Music & Memory. While the logistics of personal playlists was beyond the scope of her study, she adapted the idea of offering favorite music to patients using five different music genre playlists (synthesizer, heart, piano, orchestra and jazz). The playlists were based on other published research regarding how a musical selection’s tempo, low pitch and repetitive rhythm could lower a patient’s heart rate and blood pressure, easing anxiety.

Focusing on patients in her hospital’s trauma Intensive Care Unit and trauma orthopedic unit, Johnson conducted a randomized, controlled study of patients 55 and older. Twenty patients were given a choice of what kind of playlist they preferred, and 20 in the control group received standard care. For the playlist group, over a course of three days, Johnson offered the music for 60 minutes, twice a day, at 2:00 and 8:00 p.m. If the patients were discharged from the trauma unit after two days, that ended their involvement in the study.

Study participants were screened for delirium at the outset; all were clear of symptoms. Johnson administered assessments for confusion and delirium throughout the course of the three days, and recorded vital signs every four hours during that period.

The results? In the music intervention group, there was a statistically significant reduction in heart rate and systolic blood pressure, versus no change for the control group, indicating that the intervention had helped to reduce patient anxiety. None of the patients in either group developed symptoms of delirium over the three days; if she were to repeat the study, Johnson says she would use a more sensitive assessment tool to discern if patients were experiencing hypoactive delirium, which is more difficult to detect.

“Can’t I Just Keep the Music Here?”

In addition to the encouraging measured results, Johnson says the patients who received the music intervention were enthusiastic: “Patients asked me, ‘Can’t I just keep the music here, so I know when I become anxious I can put it back on? It helps me to sleep.’”

Nurses, too, loved the music. “They caught on and said it was awesome,” says Johnson. Trauma nurses caring for younger adults who didn’t qualify for the study followed Johnson’s lead and asked pateints’ family what music their family member preferred. Usually the answer was hard rock, quite different from the anxiety-reducing music on Johnson’s playlists. But, she says, “they calmed right down. It was quite amazing.”

Johnson adds that another patient who had suffered a stroke, who was refusing to sit up, eat or talk, and who threw things at the staff, was also soothed by her favorite music. “The nurses called me over for advice,” she says. “One of them called the patient’s sister to find the music she loved, Big Band songs. The nurse pulled it up on her phone, and after the fifth song, the patient was sitting up in her chair, cooperating, talking and eating.”

Johnson would like to see a personal music assessment become part of the standard hospital admission process, with patients having access to preferred music during their hospital stay.

While more research needs to be done, Mark Hammond believes that personal music, among other advantages, has the potential to reduce reliance on medications to reduce pain and confusion during hospital stays—given that many of these medications are a “double-edged sword” that can provoke onset of delirium.

“If we could prevent delirium, we could change lives,” he says. “We’d reduce the patient’s chances of dying after hospitalization, being moved to a nursing home, dependent on others for activities of daily living. We’d reduce fall rates and fractures. Prevention is so much more effective than treatment.”

Founded in 2010, MUSIC & MEMORY® is a non-profit organization that brings personalized music into the lives of people with cognitive or physical conditions through digital music technology, vastly improving quality of life.

As the afternoons grew longer, Forrest would become agitated. He’d tell his son, Steve, in no uncertain terms, to bring him his car—despite the fact that Forrest had Alzheimer’s and could no longer drive. But listening to Elvis and other personal music favorites would enable him to calm down.

“The music would just mellow him out,” recalls Steve of his father’s experience with Music & Memory at Morning Pointe Assisted Living in Columbia, Tenn. “They could use music instead of his anti-anxiety medications. It all depended on the timing. He would sundown about the same time every day. If they put music on around 4:30 or 5:00, he’d calm down, tap his foot and sing.”

The same was true for Ed, a resident at Louisiana’s Morgan City Health Care Center, who would relax and cease being combative when he listened to his musical favorites. “He didn’t like to be surprised. I think that was the main thing,” says his wife of 56 years, Madelyn. “If the aides would walk in and go to change him, he would grab their arms and hold them real tight. Someone would have to pry his fingers off. He was a gentle giant all his life, but he would do it to me, too. It was the sickness.”

A big man, Ed suffered from dementia brought on by Parkinson’s. But listening to Cajun or Country Western tunes would make all the difference in his moods. “If they would put his earphones on, he’d quiet down and go along with almost anything they wanted,” recalls Madelyn. She adds that, as a result, Ed’s personal music playlist helped his aides to stay safer, too.

Research Supports Non-drug Approaches to Dementia Patients’ Common Symptoms

Forrest and Ed’s experiences with Music & Memory’s personal music program underscore the potential for non-drug interventions to ease dementia-related agitation and aggression. Indeed, in 2015, researchers from the University of Michigan Medical School and Johns Hopkins University concluded, after reviewing two decades’ worth of studies about overuse of psychotropic medications for people with dementia, that “non-drug approaches should be the first choice for treating dementia patients’ common symptoms, such as irritability, agitation, depression, anxiety, sleep problems, aggression, apathy and delusions.”

“The Program Works”

Steve initially doubted the effectiveness of Music & Memory’s personal music program. After watching Alive Inside: The Story of Music & Memory, he was cynical. “I thought they just cut out all the bad stuff so it would be good for marketing. No way the music’s impact could be that instantaneous,” he says. “Until I did it with Dad. The program works.”

The head of a local insurance agency for many years, Forrest was the kind of man who “never met a stranger.” Steve adds, “Even with dementia, he’d try to sell you insurance. He’d be going into the hospital and say when we get done here we’re going to talk about insurance.” Watching his father change from such an outgoing individual who loved people to become angry and agitated when he sundowned was difficult, to say the least.

With his music—Forrest’s all-time favorite was Achy Breaky Heart—he would be more like his old self. “He’d smile more, he was happy,” says Steve. “He was always jovial. You could tell when he was having a bad day. The music would just lighten him up.” Diagnosed with aggressive liver cancer in August of 2017, Forrest died the following February. “Even in his last few weeks, when he wasn’t eating much, he still had the music playing,” says Steve. “He wasn’t as responsive, but I could tell he was loving it because he wasn’t as restless.”

“I Just Want Others to Benefit, as We Did”

Ed’s wife, Madelyn, remembers him as a “gentle giant.”

For Madelyn, her husband’s personal playlist markedly improved his quality of life after he had become a flight risk at Morgan City. When first admitted last December, Ed would sit in his wheelchair by the doorway and wait until someone opened the door wide enough to wheel through. “The last time, they found him in the middle of the street, with traffic stopped on both sides,” she says. As a safety precaution, staff placed a brace around Ed’s leg to keep him from rolling his chair, as well as an alarm that would trigger if he came near the door. In turn, Ed became more withdrawn—and combative.

But when he listened to the Cajun music he grew up with, performed by artists like Iry Le Jeune, and Country Western hits by George Jones, Ed’s distress eased. A former welding inspector who ran crews on oilrigs off Louisiana’s Gulf Coast, he had been a man who made friends easily. Madelyn describes him as “always so compliant,” agreeable, willing to accept his limitations as his disease progressed—until he felt confined at the nursing home. Toward the end of his life, the music would also help her to feed him, whereas when agitated, he would turn his back.

Ed died in September. At the wake, Madelyn told her sister that his mouth didn’t look quite right. “That’s because he’s always smiling and laughing,” her sister said. Madelyn laughed and agreed. “He loved people, loved to talk, would walk up to you and introduce himself,” she says. “Music & Memory is a marvelous program. It helped my husband a lot, and me, too. I just want others to benefit, as we did.”

Personal music may ease swallowing issues for people with advanced dementia, according to a 2018 study published in Dementia: The International Journal of Social Research and Practice. Promising results reported in the pilot study, conducted at Columbia Health Care Center in Wyocena, Wisc., in collaboration with Music & Memory and researchers at Stony Brook University, indicate that personal music has the potential to improve food intake, nutrition and hydration at a critical point in the disease process.

Five years ago, Columbia Health Care Center was one of the first nursing homes in Wisconsin to become a MUSIC & MEMORY® Certified Care Organization. In 2015, staff recommended using the personal music program as a Quality Assurance (QA) initiative, to explore how it could best benefit residents and the care environment. Since progressive dementia can make swallowing more difficult (dysphagia), causing reduced ability to eat and resultant weight loss, the QA team decided to explore whether listening to personal music could possibly ease dysphagia and related eating problems.

Over three months, an interdisciplinary clinical team tracked resident food intake following use of personalized playlists a half-hour prior to dinner. The study focused on five residents with the greatest difficulty swallowing or feeding themselves. (One was eventually eliminated from the study due to overstimulation from listening to the playlist.)

Results were encouraging. Average food intake for the four subjects without the Music & Memory intervention was 41.4 percent; when personalized playlists preceded supper, the average food intake increased to 71.4 percent, a statistically significant change. Among the team’s observations, swallowing and nutritional status improved, while choking incidents during mealtime declined. In addition, the subjects’ weight stabilized and they had less need for speech interventions or thickened liquids. Overall quality of life was enhanced.

While the sample size was small, the results are encouraging, says lead researcher Stephen Post, PhD, Director of the Center for Medical Humanities, Compassionate Care and Bioethics at Stony Brook University School of Medicine. “Personal music is more than just a matter of bringing people a little bit closer to who they are for a period of time,” he says. “The pilot study actually suggests there can be a real, functional, physiological outcome.”

Although a decline in eating and ability to eat is a natural part of advanced dementia, using personal music to facilitate swallowing before the disease reaches a terminal phase could potentially enable the individual to enjoy eating and maintain weight for a longer period of time.

Help with Swallowing Enhances Quality of Life for the Individual, Family and Caregivers

Using personal music a half-hour before dinner to help the individual to relax and have an easier time swallowing, self-feed, if possible, and avoid choking has other benefits, as well. Music & Memory’s Robin Lombardo, Northeast Regional Director and a study co-author, says that for a person in an assisted living memory care unit, for example, choking episodes may tip the scales toward a move to a more enhanced care environment, such as a nursing home. That can be a traumatic experience for the resident, triggering anxiety and other complications.

Weight loss and choking issues are, understandably, red flags for any care organization. “Being able to prevent that from happening, or postpone the inevitable, enhances the individual’s quality of life and time spent with family,” she says.

“People do panic when someone they love is not taking much in,” agrees Post. For both caregivers who assist with oral feedings and family members, an intervention that helps ease the stress of mealtimes can be a huge boost.

All too often, he notes, the alternative to dysphagia in people with advanced dementia is a feeding tube—or Percutaneous Endoscopic Gastrostomy (PEG) tube—which is inserted into the abdominal wall to pass nutrition, fluids and medication directly into the stomach. While this may be medically necessary for certain individuals, there are significant downsides, including risk of infection and aspirational pneumonia. Individuals with dementia who have PEG tubes may be put in restraints to keep them from pulling out the tube, which presents a source of confusion. In addition, the feeding tube reduces the stimulation of eating and interpersonal relationships so integral to assisted oral feeding.

The pilot study’s encouraging results are attracting attention of nursing departments in other MUSIC & MEMORY ® Certified Care Organizations that want to see if they can replicate the Columbia findings, according to Robin Lombardo. A large scale controlled research study is “logistically complex,” says Post, but would be the logical next step to clarify outcomes and define best practices.

“I’d like to get to a point where no feeding PEGS are used on people with dementia,” he says. “It’s important to think about the quality of life for a person with dementia. When you put a bolus of food into their stomach, the stimulus of eating is lost as well as a relationship at a deep, ritualistic level. If you have oral feeding available, the person will probably do pretty well for a while before fading away. If Music & Memory can make this alternative more plausible and easier to manage, that’s a big advantage.”

Founded in 2010, MUSIC & MEMORY® is a non-profit organization that brings personalized music into the lives of people with cognitive or physical conditions through digital music technology, vastly improving quality of life.

We profiled Ginny Hauser, a devoted volunteer in Pullman, Washington, in 2015. Here’s an update on how MUSIC & MEMORY® is helping to ease transitions of care on the Palouse.

Ginny Hauser shares a personal music playlist with a resident at Avalon Care Center.

In 2013, when recently retired Ginny Hauser began training as a patient support volunteer at Pullman Regional Hospital, her class went to a screening of Alive Inside. That experience inspired her to ask if personal music could become part of her volunteer work with patients. The answer was yes, and MUSIC & MEMORY® on the Palouse was born the following December.

Today, Ginny is the lynchpin of a model program in southeastern Washington State that brings personal music to individuals as they transition through stages of care in the Palouse region. Participating Certified MUSIC & MEMORY® Care Organizations include Pullman Regional Hospital, serving the city of 31,000 and surrounding rural community; Avalon Care Center, a skilled nursing facility; Circles of Caring Adult Day Services; and Friends of Hospice, which supports those at end-of-life or living with chronic health conditions in private homes and adult family homes.

A music lover who plays the flute and sings in a choir for people in hospice, Ginny serves as volunteer coordinator for MUSIC & MEMORY® on the Palouse as well as a volunteer at all of the care settings, bringing personalized playlists to individuals wherever she goes. She derives deep satisfaction from seeing hundreds of people benefit from the power of personal music over the past four years. “Music is so important to me in my life, it touches my heart,” she says. “That I can help someone else by giving them music is so valuable.”

Tailoring Playlists to Individuals and Care Settings

To efficiently cover such a broad range of organizations across a rural region, Ginny works closely with staff at the various care settings. “All of our equipment is in heavy and continued use,” she notes. Each resident who enters Avalon Care Center is offered the option to have personalized music. Ginny creates the playlist that Avalon staff then introduce to the resident. She also creates tailored playlists that staff use daily for every participant at Circles of Caring.

Friends of Hospice has its own music devices and speakers, as well as a staff member who helps to set up the playlists on equipment that Ginny delivers to patients around the county. She has created Comfort Music playlists for patients who are anxious, in pain or near end-of-life, benefiting the individual, as well as family and staff. She also co-facilitates twice-monthly Rural Resources support groups for caregivers at home and helps them to develop playlists for their family members, using equipment from Friends of Hospice.

Inspired by the Power of Music to Bring Joy and Ease Pain

Watching people light up with smiles as they hear their musical favorites keeps Ginny invested in her intense volunteer commitment. She recalls the words of a longtime Avalon resident who has two music devices, one to listen to while the other charges: “Music is really soothing. It calms me down. The songs I like make me happy.”

Or the story told by an Avalon caregiver of a longtime resident: “When you put her headset on and play her music, she lights up, sings and dances in her wheelchair. She is happier, her cognition improves, and she engages with people and her surroundings. The music brings her out of her shell. She loves to hum along and sing the lyrics.”

Ginny notes that, at the request of an occupational therapist, she has created playlists for Avalon’s therapy gym that help patients feel more comfortable doing their exercises. “The tempo and beat of the music can help with gait work,” she adds. At Circles of Caring, which serves people with dementia and other cognitive conditions, staff praise the program for the way favorite music provides respite from agitation and comforts individuals who are having a rough day.

“Many of our patients are able to continue having access to their music as they move within the various care settings on the Palouse,” adds Ginny. Several families were so inspired by the experience that they asked her how to continue the music at home. At her suggestion, family members purchased a digital music device and rechargeable speaker. “I gave them each a list of their loved one’s music and talked them through how to re-create the playlist at home,” she says. In subsequent conversations, “I heard from each that their dear one was continuing to enjoy music and that they were so thankful that they could do something that would have a positive response.”

Building an Integrated Approach to Transitions of Care

For other communities considering such an integrated approach, Ginny has a few suggestions:

Public libraries can be a key setting for Music & Memory community outreach. Depending on available resources, she notes that they might need to limit participation to hospice patients, those with terminal health diagnoses, or other long-term health situations that impact quality of life, before offering services to the general public. Libraries are ideally suited to apply for grants and donations, and to widely publicize the program. They also often have a loyal corps of volunteers.

To provide continuity of care as an individual transitions from one care setting to another and possibly back home, social work staff can play an essential role, communicating with the next placement setting about the person’s need to access personal music. This communication would identify musical favorites and whether the person prefers a headset or speaker. Once personal music is added to the individual’s care plan, the playlist could follow them from one care setting to the next.

Founded in 2010, MUSIC & MEMORY® is a non-profit organization that brings personalized music into the lives of people with cognitive or physical conditions through digital music technology, vastly improving quality of life.

“I always want an element of my work to be philanthropic,” says musician Paul Johnson.

For Nashville musician Paul Johnson, MUSIC & MEMORY® is more than a non-profit organization that deserves his financial support. It’s a reminder of a conscious choice to make music his life’s work. “Here’s why we’re making music,” says Paul. “When it becomes an important part of someone’s life, that’s a powerful and beautiful thing.”

Music has been part of Paul’s life for as long as he can remember. Growing up in Fargo, N.D., he was surrounded by singing and harmonizing. His parents met in a college folk trio, and guitars were always within easy reach at home. Paul was also surrounded by a close-knit family. His paternal grandfather, Bob, and extended family lived just across the Red River in Minnesota.

When Paul was a teen, Bob developed Alzheimer’s. His father would often visit and help with Bob’s care. Their relationship made a huge impression on Paul, as he watched first-hand how his grandfather’s health and mental ability deteriorated over the last years of his life.

“What was equally as impactful, if not more so,” he says, “was to see the effect on my Dad, slowly losing his parent, but also, in that loss, finding places to celebrate. Those moments of presence and light were all the more important.”

A Reminder of Music’s Personal Impact

So when Paul, now a full-time professional musician, happened across the Music & Memory documentary Alive Inside while surfing Netflix several years ago, he was deeply moved: “I remembered how a good day could be such a breath of fresh air, a day when you saw a little of the person that you knew. I wished we’d had this information sooner, to try it with my grandfather.”

Music & Memory’s mission to spread the power of personal music also struck a chord with Paul: “How music can be a soundtrack for important moments in people’s lives, how it benefits both individuals and their caretakers. As a musician, I was really affected by the way the music could be impactful.”

Paul’s musical career has evolved over the past decade, beginning when he came to Nashville as an 18-year-old to study the business of music at Belmont University. That lasted a year. Paul’s real passion was playing music and song-writing, so he began working part-time as a session player for other musicians, and in the process, learned to produce his own compositions.

For the past three years, he has worked full-time writing songs, producing them, and performing under the name Canyon City Building an online audience via Spotify, Apple Music and YouTube videos, he describes his style as “indie folk.”

Philanthropy as a Business Cornerstone

Paul with his sister, Emily, and grandfather Bob Johnson

Recalling his grandfather—known as Big Red because of his tall stature and red hair—Paul is wistful.

“He was a humble guy, not one to brag about his experiences,” he says of the man who was first in his family to go to college with a basketball scholarship, earned a doctorate in physical education, helped found Southwest Minnesota State University, started his own business and served in the 82nd Airborne.

“He didn’t recommend jumping out of planes!” says Paul. “He was always hardworking. Family was really integral to him.”

As Bob’s life drew to a close, Paul says, “I felt like I was getting to know him as he was going. You hear all these stories, windows into the seasons of life. It was like meeting and losing a person at the same time. My hope, as I get older, as my family and friends get older, is that there will be treatments available that will allow us to have those moments of presence more often than not.”

Supporting Music & Memory was a natural step toward realizing that hope. “I always want an element of my work to be philanthropic,” says Paul. “It helps me to have that commitment, to help the world as I move through it. As Canyon City grows, I want to build in ways to be generous and doing good. Music & Memory was an obvious choice to support. It’s about more than the music. It’s a consistent reminder to me why this is good work.”

Founded in 2010, MUSIC & MEMORY® is a non-profit organization that brings personalized music into the lives of people with cognitive or physical conditions through digital music technology, vastly improving quality of life.

In thousands of MUSIC & MEMORY® Certified Care Organizations, we’ve witnessed time and again how musical favorites can help people with Alzheimer’s and other dementias reconnect with the world. Now, a team of researchers at the University of Utah Health in Salt Lake City have demonstrated the brain chemistry underlying that remarkable reawakening.

A study published in the April online issue of The Journal of Prevention of Alzheimer’s Disease reports how the U of U Health team found preliminary evidence that familiar music may facilitate attention, reward and motivation, which in turn makes it more possible to manage emotional distress in Alzheimer’s.

As Alzheimer’s progresses, language and memory centers in the brain are the most vulnerable to damage. However, certain brain networks remain relatively functional—in particular, those areas responsible for attention, known as the salience network. This is the same part of the brain that registers the thrill of listening to favorite music in a person who is cognitively healthy.

So researchers wondered: Would musical favorites “light up” the salience network of someone with Alzheimer’s during an MRI brain scan? To find out, they recruited 17 participants with dementia to undergo MRIs as they listened to 20-second clips of music from their personalized playlists. For each participant, researchers played eight music clips, the same eight clips played in reverse, and eight blocks of silence.

Musical Favorites Stimulate Several Areas of the Brain

MRI image comparisons indicated that musical favorites stimulate several areas of the brain: not only the salience network, but also visual, executive and cerebellar networks. All showed significantly higher functional connectivity with music versus silence.

According to Norman Foster, M.D., Director of the Center for Alzheimer’s Care at U of U Health and senior author of the study, the research provides “objective evidence from brain imaging that shows personally meaningful music is an alternative route for communicating with patients who have Alzheimer’s disease.”

While the study’s small sample size and single imaging sessions leave room for more research to be done, the findings mark a significant step toward demonstrating how Music & Memory’s personalized music program is a therapeutic mechanism to address measurable improvement in mood, awareness and quality of life for people with dementia.

“This is an exciting development as we watch researchers in the U.S. and around the world continue to ground our work in evidence-based science,” says Dan Cohen, Music & Memory founder and Executive Director. “Personally meaningful music should be considered as a standard of care for all people with dementia.”

Founded in 2010, MUSIC & MEMORY® is a non-profit organization that brings personalized music into the lives of people with cognitive or physical conditions through digital music technology, vastly improving quality of life.

It was one of those challenging days at a nursing home near Indianapolis. A resident with late stage dementia was agitated, trying to get up from his seat and walk, although he was at risk of falling. Tending to him, nursing staff were unable to spend time with other residents and complete work that had to be done. Everyone was stressed.

That’s when speech language pathologist Natalie Scott pulled out a digital music device and began playing some of the man’s favorite music. “I was covering for another therapist, trying to work on verbal expression,” she recalls. “He was able to sit in his recliner and listen. When I turned off the music, within a minute or so, he said, ‘I was listening to that.’ The nurse told me she had never heard him speak before.”

As Natalie shared online images with the resident, she soon discovered that he was a retired fire chief. After viewing pictures of fire trucks and other equipment, he told her he wanted to get his fire hat. “It was a really great session,” says Natalie. “And the CNA’s and nurses were able to finish lunch with the other residents and distribute meds. It was pretty amazing.”

That experience inspired Natalie and physical therapist Jan Bays to team up and promote Music & Memory’s personalized playlist program to support a range of therapeutic applications, including physical therapy (PT), occupational therapy (OT) and speech language pathology (SLP).

“Music & Memory helps set up the person to do the therapy task successfully,” says Jan, now Director of Program Development and Education for Jill’s House in Bloomington, Indiana. “It makes the garden fertile.”

For example, when someone with a hand problem sees an occupational therapist, they may experience a lot of frustration and pain, trying to get their hands to move once again or regain strength, coordination and range of motion, explains Jan. Listening to their favorite music can help to distract them from discomfort and stay motivated.

The same holds for physical therapy. “One of the first successes that we had involved a person who really needed to work on repetitive exercises on an exercise bike, to increase range of motion and aerobic capacity” she says. “The therapist just couldn’t get them to do it for even five minutes. We put on the personalized music and they did it for 15 or 20 minutes.”

For elders with dementia or other cognitive impairments, says Natalie, personalized playlists can be used to arouse attention and help with self-feeding: “As someone is more alert and able to self-feed, it also directly reduces the risk of swallowing difficulty, because they are better able to self-monitor.”

There are many more ways to enhance therapy with personalized playlists. For example, playing the individual’s favorite music 15 minutes before a therapeutic session, such as personal care training for Activities of Daily Living (ADLs), can be invigorating and increase alertness and attentiveness to the task. Jan adds that when the person is depressed and even less willing to participate in therapy, that special music can give them a “big dopamine dump,” which boosts their involvement.

Together, Jan and Natalie offer a two-day webinar through Music & Memory, specially designed for PT, OT and SLP therapy applications. Therapists who work in a MUSIC & MEMORY® Certified Care Organization are eligible for the training; once they have completed the webinars, they can introduce the program to other MUSIC & MEMORY® Certified Care Organizations where they consult. The webinars explain Music & Memory’s particular benefits for these therapies; specific applications for people with dementia, medical complexities and those in short term rehab; as well as the nuts and bolts of documentation, billing and program development.

Building Quality Relationships with Personalized Playlists

In addition to improving patients’ attention and willingness to perform tasks, personalized playlists can help therapists to build the quality personal relationships that are so essential to a successful outcome. Favorite music “helps to make that connection with skills that are old and already known,” says Jan. “It’s helping the person attend to the past. It’s helping the person to find the energy and attention to relate. You have to make that connection and create a relationship before you can effectively teach. Therapists are invading people’s personal spaces, and you have to have a relationship with someone to successfully invade their space. Personalized music is a great way to do that.”

Therapists and their patients aren’t the only ones to benefit. Family members do, too. “It’s very common when family visit someone with a cognitive impairment, they don’t know what to say or do,” says Natalie. Sharing a personalized playlist can help to bridge that gap: “I can come up with a functional communication task to help communicate with their family member, to facilitate automatic verbalizations, the ability to appropriately engage and communicate.”

For caregivers, personalized music is also an important tool. Therapy, explains Jan, has three major goals: to restore function, to teach compensatory strategies for functions that can’t be performed in their customary way, and to adapt the person’s environment for success. Educating caregivers how to use personalized playlists at home to enhance the patient’s follow-through with therapy can reap huge benefits for all involved. “Music & Memory is a big way to adapt the person’s environment,” she says.

“What we have to do, especially for people living with dementia, is to give them an environment in which they feel competent,” says Jan. “They know who they are and they know what to do. Music & Memory makes that connection to a time when the person was competent and they felt comfortable.”

Founded in 2010, MUSIC & MEMORY® is a non-profit organization that brings personalized music into the lives of people with cognitive or physical conditions through digital music technology, vastly improving quality of life.

Inspired by the power of personalized music, Anne Brazil has decided to include Music & Memory in her will.

Anne Brazil was surfing Netflix one day when she discovered a video that moved her so profoundly, she had to act. The video was Alive Inside: A Story of Music and Memory.

“I admire how Dan Cohen has not only improved the quality of life of many lonely souls, but literally sparked their long-lost vitality,” says Anne. “He takes a simple iPod loaded with music to a nursing home, places the headphones on the patient, and something magic happens. No pills, no shots, no surgery, nothing invasive, just a simple, loving gift of music, and the person is miraculously changed. Eyes pop open, a smile appears, hands wave and toes tap.”

For this former music teacher with a Master of Social Work, the concept was captivating. “What can I do to support this remarkable program?” she wondered.

A Bequest for MUSIC & MEMORY®

Anne mailed a check to Music & Memory, asking only that it be used however her donation could make the greatest impact. In response, she received a personal thank you card from Dan. “He didn’t flood my email with pleas for more, and he didn’t stuff my snail mail box, either,” she says. “This program is a cut above.” As she learned more about the organization’s efforts to spread the power of personalized music, Anne considered dedicating a portion of her estate to Music & Memory.

“For years I was just a teacher on a salary with a kid,” she explains, as she scans the Pacific Ocean from her home in Cayucos, a small fishing village about two hours north of Santa Barbara. ““I squirreled away every refund, every bonus, every royalty. When I had saved enough, I picked up another house or apartment. Soon I traded up to larger properties to build my holdings. Finally, I was able to take the leap to California’s beautiful central coast. I’m really blessed.”

Sharing the Healing Power of Music

A California native who grew up on a farm, Anne first learned to play the clarinet in school and later, many other instruments. (Her musical favorites include Gregorian chants, Mozart, Leonard Cohen, the Three Tenors, the Pentatonix, and Rock ‘n Roll.) After earning a degree in music, she taught beginning instruments, then branched out to vocal and instrumental instruction at all school levels over her 40-year career.

“Music changed my brain, too,” she says. “It repaired the broken synapses of words and reading. It led me out of the shame of dyslexia. I was able to achieve success academically and professionally, thanks to the healing power of music.”

World travels included teaching gigs in Japan, Germany and Portugal. In midlife, when a teaching promotion fell through, Anne decided to broaden her professional credentials and went back to university to earn a Master of Social Work: “I didn’t change careers after all, but relocated from farm country to the beach, to share my music with little surfers and sun worshippers.”

Time to Give Back

Now retired and enjoying the fruits of her careful saving and investments, Anne decided it was time to give back. “I’m a senior citizen myself,” she says. “I’m fortunate to have the means to last my remaining years. All my needs are met and almost all my wishes. It was time to put my desires on paper.” In the process of drafting her will, she decided to include Music & Memory as a beneficiary.

“My quality of life is ample,” she says. “But I realized there are some older people who are really suffering. They’re locked inside themselves. If we can give someone another year or even a month of fun, we should do it—with a smile and a laugh and love!

“I’m leaving this world with empty hands, anyway, so why not endow a portion of my estate to Music & Memory, where it will help to restore vigor to so many? We are here to help each other. That is my purpose.”

Founded in 2010, MUSIC & MEMORY® is a non-profit organization that brings personalized music into the lives of people with cognitive or physical conditions through digital music technology, vastly improving quality of life.

Manon Bruinsma directs Music & Memory in the Netherlands and guides international expansion.

It all began in 2008 as an experiment with a handful of residents in four New York nursing homes. In the ten years since, MUSIC & MEMORY® has brought the power of personalized music to every state in the U.S., as well as Canada, Australia, Europe, the Caribbean, Israel and South Africa. And pilot programs are underway in Japan.

Shepherding Music & Memory’s international expansion is Manon Bruinsma, a music therapist based in the Netherlands, who first heard of the program when she viewed the Henry video online. “People kept sending it to me and telling me this is going to be your thing!” she says. “It struck me like lightening.”

That was just the beginning of what has become a passionate life’s journey to bring the benefits of personalized music to her home country, as well as the rest of Europe and beyond.

Launching International Expansion from the Netherlands

Manon’s first step was to contact Executive Director Dan Cohen, who put her in touch with another Dutch music therapist. Together, they took Music & Memory’s training and began to set up personalized playlists for some of their clients—and learned a few lessons. “I thought the headphones would be isolating,” she says. “And I thought people who were musical all their lives would respond the most positively, while people who had no musical involvement would not.” Both assumptions proved to be false.

Intrigued by how Music & Memory was improving quality of life in nursing homes where she worked, Manon volunteered to field questions about the program from people outside the U.S. She also continued to advance the use of personalized playlists at nursing homes in the Netherlands. Then, in April 2015, she traveled to New York City to meet with Dan and formalize the founding of Music & Memory in the Netherlands; in addition, Dan asked Manon to direct the organization’s European outreach efforts.

That role has vastly expanded to encompass the rest of Europe and Quebec. Today, there are 48 MUSIC & MEMORY® Certified Care Organizations in the Netherlands, including two on the Dutch Caribbean island of Curaçao. Manon has also helped to train care professionals in Quebec, the United Kingdom, Germany and Switzerland—she speaks Dutch, English, German and French.

Beyond Europe, five nursing homes in Israel are running pilot programs. Two nursing homes in Japan are also running pilots. Then there is Our Parents Home in South Africa, Music & Memory’s first site on the African continent.

Through other partnerships, there are more than a hundred MUSIC & MEMORY® Certified Care Organizations throughout Australia and nearly 300 in Canada. And the inquiries keep coming—from Hungary, Denmark, Sweden, Austria, France, Italy, Poland, Portugal, Spain and Argentina. Research about the benefits and impact of personalized music is underway at universities in the Netherlands, Germany and Poland.

Cross Cultural Differences and Similarities in Caring for Elders

Keeping on top of it all is certainly a challenge. Manon travels across Europe to bring in-person training to new countries—first testing out translated materials and adjusting for cultural nuances in one key nursing home before expanding online training to other care communities in that country. “I feel like I have to scale up on a monthly basis,” she says. “But it’s hugely rewarding. When nursing homes at the forefront of dementia care adopt the program, it spreads from there.”

The experience has highlighted cross-cultural similarities in elder care, as well as some striking differences. Budgets are being cut everywhere, Manon observes. High staff turnover is a persistent challenge, in part, she believes, because many countries are trying to keep people at home longer. By the time they are placed in a nursing home, they are much sicker, creating more stress for staff.

But, she adds, quality of care differs greatly from country to country, depending on tax revenues and the degree to which each government is involved in running the homes. In the Netherlands, for example, almost all nursing homes are publicly owned; compulsory public long-term-care insurance supports a high standard of care. In the U.K., by comparison, 70 percent of the homes are private. France requires families to be involved in their family member’s care, including bringing food, to get a placement.

Emphasis on Keeping People at Home as Long as Possible

Across Europe, she sees a trend toward favoring home care over nursing homes. As Music & Memory develops new training for home care agencies here in the U.S., the demand for parallel training for European countries, as well as family caregivers, will undoubtedly increase.

Manon’s big dream, to help meet the need, is to partner wealthier Northern European countries with Southern European countries that have fewer resources. “I had a call from someone in Hungary who wants to get Music & Memory running in their town, but its too expensive,” she says. “I would love to get a country like Denmark or Sweden to be their sponsor.”

Whatever the hurdles, Manon finds the work of Music & Memory’s international expansion to be deeply rewarding. “The greatest thing is always getting a video or picture about how well it works, how it’s changing lives of so many people,” she says. “The way that people respond to music is universal. People ask me if I miss the one-on-one contact as a music therapist, but every time I hear a story that this worked, it’s worth it. Music & Memory has widened my world.”

Founded in 2010, MUSIC & MEMORY® is a non-profit organization that brings personalized music into the lives of people with cognitive or physical conditions through digital music technology, vastly improving quality of life.

Carol Ann Jones chats with an audience member after a Power of Music performance.

John was nearing the end of his life, no longer able to speak, when Carol Ann Jones brought her guitar to his bedside at a Vermont nursing home for another visit. She began to strum one of his favorite songs, Me and Bobby McGee. John’s brothers were there, and one joined in with his harmonica. Everyone sang. John’s eyes opened wide.

“There was so much love in that room,” says Carol Ann. “You could see his body relax. You could see the joy in his eyes. He lifted his arms up and was waving to the music. When I got to the end of the song, all of a sudden all these voices joined me. He was waving people into the room—nurses, the chaplain. It was incredible.”

Not long after, John died on Thanksgiving weekend. His wife called to thank Carol Ann for all her musical visits to his bedside. She attended his funeral. The experience inspired her to write his story in a new journal—the first of many stories of the hospice patients she played for at Saint Albans Healthcare and Rehabilitation Center. By the time the journal was full, she had written about more than 180 people’s end-of-life journeys.

Raising Awareness and Funds for MUSIC & MEMORY®

An award-winning recreation assistant at Saint Albans who loves to play her guitar and sing for the residents, Carol Ann also helped to launch the 85-bed care community’s Music & Memory program. She creates and updates personalized playlists for people in the memory care unit and runs bake sales and other fundraisers that have enabled Saint Albans to acquire 15 digital music devices. Inspired by a screening of Alive Inside, she volunteers her time for administering the program, in addition to her part-time paid work in recreation therapy.

Now Carol Ann has put her love of playing live music for residents and her experiences with hospice patients toward a new musical endeavor to raise money for Music & Memory and spread awareness of the personalized music program throughout Vermont. Inspired by a friend who loved the stories in her journal, she decided to write a one woman play based on 12 of the most interesting people she had met and sang for.

“The story of John is the first one,” she says. “Then I play a couple of his favorites, Bobby McGee and Red River Valley. Then I go on to the next one, a very different story and music. There’s a wide variety.” At each performance, she includes a display of literature about Music & Memory and Alzheimer’s, as well as a box to collect digital music devices.

After her debut in Saint Albans last July, people encouraged her to take her show on the road. “I’m going to do every county in Vermont,” says Carol Ann, thanks to a $5,000 donation to Music & Memory from an enthusiastic member of the Saint Albans audience. At each stop, she makes a point to connect with the local home hospice agency and collect digital music devices for the nearest MUSIC & MEMORY® Certified Care Organization.

Building Personal Connections Through Beloved Songs

In addition to her Music & Memory road show, Carol Ann performs folksong singalongs at care communities around the state, as well her own show at area coffee houses. She also runs half marathons. A former accountant, she keeps the books for the family dairy farm. Even as the competitive organic milk market forced Carol Ann and her husband to make tough decisions about selling their dairy herd last June, she credits her husband with encouraging her to stick with her music.

What keeps her going—both playing for residents and promoting Music & Memory—is the personal connections she builds through beloved songs. “It’s the joy, the pure, simple joy that you can bring. The awakening that happens,” says Carol Ann. “It turns people around from being so lost and so confused and sad to, ‘Hey, I’m with you!’ It doesn’t matter where we are, we’ve connected and we have this music, this sharing going on. It’s just priceless.”

Founded in 2010, MUSIC & MEMORY® is a non-profit organization that brings personalized music into the lives of people with cognitive or physical conditions through digital music technology, vastly improving quality of life.